Hip joint device, system and method

ABSTRACT

An implantable medical device for implantation in a hip joint of a human patient is provided. The medical device comprises: at least one artificial hip joint surface adapted to replace at least the surface of at least one of the caput femur and acetabulum. At least one artificial hip joint surface comprises: a positioning hole with at least one opening in said at least one artificial hip joint surface. The hole is adapted to be placed and dimensioned such that the medical device is adapted to be fitted using a positioning shaft and at least partly surround the shaft, for positioning the at least one artificial hip joint surface in a desired position in the hip joint. The hole is adapted to be fitted using the positioning shaft, when the shaft is stabilized and placed in at least one of the femoral bone and the pelvic bone for positioning said medical device inside the hip joint.

This application is the U.S. national phase of International ApplicationNo. PCT/SE2010/050811, filed 12 Jul. 2010, which designated the U.S. andclaims the benefit of U.S. Provisional Nos.: 61/229,755, filed 30 Jul.2009; 61/229,738 filed 30 Jul. 2009, 61/229,739 filed 30 Jul. 2009;61/229,743 filed 30 Jul. 2009; 61/229,745 filed 30 Jul. 2009; 61/229,746filed 30 Jul. 2009; 61/229,747 filed 30 Jul. 2009; 61/229,748 filed 30Jul. 2009; 61/229,751 filed 30 Jul. 2009; 61/229,752 filed 30 Jul. 2009;61/229,761 filed 30 Jul. 2009; 61/229,767 filed 30 Jul. 2009; 61/229,778filed 30 Jul. 2009; 61/229,786 filed 30 Jul. 2009; 61/229,789 filed 30Jul. 2009; 61/229,796 filed 30 Jul. 2009; 61/229,735 filed 30 Jul. 2009;and which claims priority to Swedish Application Nos.: 0900981-2 filed10 Jul. 2009; 0900957-2 filed 10 Jul. 2009; 0900958-0 filed 10 Jul.2009; 0900959-8 filed 10 Jul. 2009; 0900960-6 filed 10 Jul. 2009;0900962-2 filed 10 Jul. 2009; 0900963-0 filed 10 Jul. 2009; 0900965-5filed 10 Jul. 2009; 0900966-3 filed 10 Jul. 2009; 0900968-9 filed 10Jul. 2009; 0900969-7 filed 10 Jul. 2009; 0900970-5 filed 10 Jul. 2009;0900972-1 filed 10 Jul. 2009; 0900973-9 filed 10 Jul. 2009; 0900974-7filed 10 Jul. 2009; 0900976-2 filed 10 Jul. 2009 and 0900978-8 filed 10Jul. 2009, the entire contents of each of which are hereby incorporatedby reference.

FIELD OF INVENTION

The present invention relates generally to a medical device forimplantation in a human patient.

BACKGROUND

Hip joint Osteoarthritis is a syndrome in which low-grade inflammationresults in pain in the hip joints, caused by abnormal wearing of theCartilage that acts as a cushion inside if the hip joint. This abnormalwearing of the cartilage also results in a decrease of the jointslubricating fluid called Synovial fluid. Hip joint Osteoarthritis isestimated to affect 80% of all people over 65 years of age, in more orless serious forms.

The present treatment of hip osteoarthritis comprises NSAID drugs, localinjections of Hyaluronic acid or Glucocorticoid to help lubricating thehip joint, and replacing parts of the hip joint with a prosthesisthrough hip joint surgery.

The replacing of parts of the hip joint is one of the most commonsurgeries to date performed at hundreds of thousands of patients in theworld every year. The most common method comprises placing a metalprosthesis in Femur and a plastic bowl in Acetabulum. This operation isdone through a lateral incision in the hip and upper thigh and through,Fascia Lata and the lateral muscles of the thigh. To get access to thejoint, the supporting hip joint capsule attached to Femur and Iliumneeds to be penetrated, making it difficult to get a fully functionaljoint after the surgery. Femur is then cut at the neck with a bone sawand the prosthesis is placed in femur either with bone cement orwithout. Acetabulum is slightly enlarged using an Acetabular reamer, andthe plastic bowl is positioned using screws or bone cement.

The surgery typically requires one week of hospitalization due to theincreased risk of infection. The recovery process is on average about 6weeks, but even after this period the patient should not perform anyphysical activates that places large strain on the joint.

The correct placement of the prosthesis or prosthetic parts is animportant part of the operation since it affects the hip joint's abilityto heal correctly, and also affects the function of the hip joint afterthe hip joint replacement surgery. Due to limited reach and visibilityinside the hip joint, the placing of the prosthesis is a difficult andtime consuming step of the operation with numerous possibilities forerrors.

SUMMARY

An implantable medical device for implantation in a hip joint of a humanpatient is provided. The hip joint comprises the caput femur shaped likea ball, being connected to the collum femur and being the upperextremity of the femoral bone. The collum femur and caput femur having alongitudinal axial distribution with a longitudinal caput femur centreaxis reaching from the collum femur, in the centre of the collum femurand caput femur and towards the acetabulum. The acetabulum is a bowlshaped section of the pelvic bone, with an opening towards the caputfemur, the acetabulum have an acetabulum centre axis reaching from thecentre of the bottom of the bowl towards the centre of the opening andthe caput femur. The caput femur centre axis is identical with theacetabulum centre axis in a special centred position, when the caputfemur being aligned, centred and symmetrical in the acetabulum. Thecaput femur and acetabulum each have a hip joint carrying surface,facing each other and contacting each other, the hip joint carryingsurfaces, carrying weight in the hip joint. The medical devicecomprises: at least one artificial hip joint surface adapted to replaceat least the surface of at least one of the caput femur and acetabulum.At least one artificial hip joint surface comprises: a positioning holewith at least one opening in said at least one artificial hip jointsurface. The hole is adapted to be placed and dimensioned such that themedical device is adapted to be fitted using a positioning shaft and atleast partly surround the shaft, for positioning the at least oneartificial hip joint surface in a desired position in the hip joint. Thehole is adapted to be fitted using the positioning shaft, when the shaftis stabilized and placed in at least one of the femoral bone and thepelvic bone for positioning said medical device inside the hip joint.

According to one embodiment the medical device comprises an artificialcaput femur or an artificial caput femur surface, which could compriseat least two artificial caput femur surface parts adapted to beinterconnected to form the artificial caput femur surface during anoperation. Each of the at least two artificial caput femur surface partscould comprise a positioning hole adapted to at least partly surround apositioning shaft.

According to one embodiment the collum femur has an axial distributionleading to the caput femur, which has a substantially ball shapedconfiguration with a maximum diameter substantially perpendicular to thecentre axis of the prolongation of the axial distribution of the collumfemur. The caput femur is normally placed in an acetabulum creating thehip joint.

According to another embodiment the artificial caput femur surfacefurther comprises at least one first beyond part of the artificial caputfemur surface adapted to cover and/or go into the bone of the caputfemur on at least a part of the caput femur beyond the maximum diameterof the caput femur, away from the acetabulum cup towards the collumfemur, when mounted on the caput femur in its functional position in thejoint. The at least one first beyond part is adapted to have a closestperpendicular distance to the centre axis, being smaller than thedistance between the periphery of the maximum diameter of the caputfemur and the centre axis. The medical device thus is adapted to createa more stable position of said artificial caput femur surface whenmounted on the caput femur in the functional position.

The hip joint has a ball shaped caput femur being the proximal part ofthe femoral bone with a convex hip joint surface and a bowl shapedacetabulum as part of the pelvic bone with a concave hip joint surface.According to one embodiment the artificial caput femur surface comprisesan artificial concave hip joint surface adapted to be fixated to thefemoral bone.

The implantable medical device could have a largest diameter or alargest cross-sectional distance, and an opening. The largest diameteror cross sectional distance is adapted to be changed during anoperation.

According to another embodiment of the implantable medical device, theartificial hip joint surface further comprises an artificial acetabulumor an artificial acetabulum surface. The artificial acetabulum surfacecould comprises a first positioning hole and a second positioning hole.The artificial acetabulum surface is adapted to be aligned with theartificial caput femur surface in a special position and adapted to usethe positioning shaft placed in at least one of the femoral and pelvicbone, placed through at least one of the first positioning hole in thecaput femur surface and the second positioning hole in the acetabulumsurface and further placed at least partly through at least one of thefirst positioning hole in the caput femur surface and the secondpositioning hole in the acetabulum surface.

According to another embodiment the artificial acetabulum surface andthe artificial caput femur surface are adapted to be in moveableconnection with each other when implanted in the hip joint.

According to one embodiment the implantable medical device is adapted tobe fixated to at least one of the caput femur, the collum femur and thefemoral bone using a fixation element, which could be a fixation elementselected from a group consisting of; at least one screw, at least onepin, at least one portion of at least one of the parts adapted to beintroduced into the other part, the parts being adapted to be slidinginto the other part, form fitting, welding, adhesive, pin, wire, a ballmounted into a bowl being portions of said parts, a male portion of onepart mounted into a female portion of the other part, a key introducedinto a lock being portions of said parts, band, and other mechanicalconnecting members.

According to another embodiment the artificial hip joint surfacecomprises an artificial acetabulum or an artificial acetabulum surface,which could comprises at least two artificial acetabulum surface partsadapted to be interconnected to form the artificial acetabulum surfaceduring an operation. Each of the at least two artificial acetabulumsurface parts could comprise a positioning hole adapted to at leastpartly surround a positioning shaft.

The hip joint has a ball shaped caput femur, being the proximal part ofthe femoral bone, with a convex hip joint surface, and a bowl shapedacetabulum as part of the pelvic bone with a concave hip joint surface.The artificial acetabulum surface, according to one embodiment, couldcomprise an artificial convex hip joint surface adapted to be fixated tothe pelvic bone.

The artificial acetabulum surface has a largest diameter or a largestcross-sectional distance, and an opening. According to one embodimentthe largest diameter or cross sectional distance could be adapted to bechanged during an operation.

The positioning hole according to any of the embodiments herein could besubstantially circular, non-circular or have a cut circumference.

The implantable medical device according to any of the embodiments couldbe adapted to inserted through the hip joint capsule or the pelvic boneand could be mounted onto said positioning shaft inside of the hipjoint.

According to one embodiment the at least two artificial caput femursurface parts could comprise a positioning hole adapted to at leastpartly surround a positioning shaft.

According to one embodiment each of the at least two artificialacetabulum surface parts could comprise a positioning hole adapted to atleast partly surround a positioning shaft.

The artificial acetabulum surface could be adapted to be fixated to thepelvic bone using a fixation element, such as a fixation elementselected from a group consisting of; at least one screw, at least onepin, at least one portion of at least one of the parts adapted to beintroduced into the other part, the parts being adapted to be slidinginto the other part, form fitting, welding, adhesive, pin, wire, a ballmounted into a bowl being portions of said parts, a male portion of onepart mounted into a female portion of the other part, a key introducedinto a lock being portions of said parts, band, and other mechanicalconnecting members.

A positioning shaft adapted to position a medical device inside of thehip joint of a human patient is further provided. The positioning shaftcould be elongated and further adapted to be introduced into at leastone of the femoral bone and the pelvic bone during positioning of amedical device inside the hip joint.

According to one embodiment the positioning shaft is adapted to befixated to the at least one of the femoral bone and the pelvic boneduring positioning of the medical device inside the hip joint.

The artificial hip joint surface comprises an artificial acetabulum oran artificial acetabulum surface. The hole, when fitted with thepositioning shaft, could be adapted to centre and hold the artificialacetabulum or an artificial acetabulum surface during fixation thereofin the hip joint.

The artificial hip joint surface could comprise an artificial caputfemur or an artificial caput femur surface. The hole, when fitted withthe positioning shaft, could be adapted to centre and hold theartificial caput femur or an artificial caput femur surface duringfixation thereof in the hip joint.

The artificial hip joint surface could further comprise an artificialacetabulum or an artificial acetabulum surface. The hole, when fittedwith the positioning shaft, could be adapted to centre and hold both theartificial caput femur or an artificial caput femur and the artificialacetabulum or an artificial acetabulum surface during fixation thereofin the hip joint.

The artificial caput femur surface could according to one embodimentcomprise a convex shape towards the centre of the hip joint, and theartificial acetabulum surface could comprise a concave shape towards thecentre of the hip joint. The artificial convex caput femur surface couldbe adapted to be fixated to the pelvic bone of the human patient, andthe artificial concave acetabulum surface could be adapted to be fixatedto the femoral bone of the human patient.

The caput femur has a convex hip joint surface towards the centre of thehip joint and the acetabulum has a concave hip joint surface towards thecentre of the hip joint. At least one artificial hip joint surfacecomprises an artificial caput femur or an artificial caput femursurface, having a convex shape towards the centre of the hip joint,comprising a first hole, and an artificial acetabulum or an artificialacetabulum surface, having a concave form towards the centre of the hipjoint, comprising a second hole. The artificial caput femur or theartificial caput femur surface and the artificial acetabulum or theartificial acetabulum surface are adapted to be centered in the hipjoint by the positioning shaft placed in said hole and at least one ofthe femoral or pelvic bone. The artificial convex caput femur orartificial convex caput femur surface has the first hole placed in theconvex part, for enabling the positioning shaft to be introduced intosaid hole and centering said artificial convex caput femur or saidartificial convex caput femur surface, when placed in the hip joint.Furthermore the artificial concave acetabulum or the artificial concaveacetabulum surface has the second hole placed in the concave part, forenabling the positioning shaft to be introduced into the hole andcentering the artificial concave acetabulum or the artificial concaveacetabulum surface, when placed in the hip joint.

The artificial concave acetabulum or the artificial concave acetabulumsurface could according to one embodiment have the second hole placed inthe centre of the concave part. The artificial convex caput femur orartificial convex caput femur surface could have the first hole placedin the centre of said convex part, adapted for enabling the positioningshaft to be introduced into said hole and centering said artificialconvex caput femur or said artificial convex caput femur surface andsaid artificial concave acetabulum or said artificial concave acetabulumsurface, when placed in the hip joint, and when said hip joint is placedin said special centered position.

The artificial convex caput femur surface could be adapted to be fixatedto the pelvic bone of the human patient, and the artificial concaveacetabulum surface could be adapted to be fixated to the femoral bone ofthe human patient.

According to another embodiment the positioning shaft further comprisesa screw thread adapted to fixate the positioning shaft to at least oneof: the femoral bone and the pelvic bone, during positioning of themedical device inside the hip joint. The positioning shaft could beadapted to be removed from the connection with at least one of thefemoral bone and the pelvic bone, after the positioning of the medicaldevice inside the hip joint.

According to one embodiment the positioning shaft is adapted to have afirst and second state. The first state is a state in which thepositioning shaft is flexible, and the second state is a state in whichthe positioning shaft is adapted to be less flexible than in the firststate.

The positioning shaft could be adapted to position the medical device inat least one axis, in at least two axis, in at least three axis and/orin at least one plane.

According to one embodiment the positioning shaft is adapted to beplaced in a positioning hole of the medical device.

The positioning shaft could be adapted to position a medical devicecomprising at least two medical device parts, and the positioning shaftcould be adapted to be placed in a positioning hole in at least one ofthe at least two medical device parts.

According to one embodiment the positioning shaft has an area,substantially perpendicular to its elongated distribution, adapted to bepositioned in said positioning hole, being substantially circular ornon-circular.

The positioning shaft is adapted to be positioned in a positioning hole,which could have a cut circumference.

The positioning shaft could be adapted to receive a medical deviceinserted into the hip joint through the hip joint capsule or through thepelvic bone.

The positioning shaft, according to one embodiment could be adapted toreceive a medical device to be mounted onto the positioning shaft insideof the hip joint.

A medical device system comprising a first medical device, according toany of the embodiments herein, and a second medical device, being amedical according to any of the embodiments herein, and a positioningshaft according to any of the embodiments herein.

According to one embodiment of the medical device system, the first andsecond medical devices are adapted to be mounted onto the positioningshaft inside of the hip joint.

According to yet another embodiment of the medical device system, thefirst and said second medical device are adapted to be mounted onto thepositioning shaft outside of the hip joint.

According to yet another embodiment the medical device system, furthercomprises an implantable lubrication system, the implantable lubricationsystem is adapted to lubricate the first and second medical devicesafter the first and second medical device has been positioned in the hipjoint.

A medical device system for use in a hip joint of a patient is furtherprovided. The system comprises a first positioning shaft according toany of the embodiments above, and a second positioning shaft accordingto any of the embodiments above. The first positioning shaft is adaptedto position a first part of a medical device in the hip joint, and thesecond positioning shaft is adapted to position a second part of themedical device in the hip joint.

According to another embodiment of the medical device system, the firstpart of the medical device and the second part of the medical device areadapted to be connected to each other after implantation in the hipjoint of the patient.

According to yet another embodiment of the medical device system thefirst positioning shaft and the second positioning shaft are adapted tobe connected to each other after implantation in the hip joint of thepatient.

The medical device according to any of the embodiments herein couldcomprise an artificial acetabulum or an artificial acetabulum surface,and the hole, when fitted with the positioning shaft, could be adaptedto centre and hold the artificial acetabulum or an artificial acetabulumsurface during fixation thereof in the hip joint.

According to another embodiment of the medical device, the artificialhip joint surface comprises an artificial caput femur or an artificialcaput femur surface. The hole, when fitted with the positioning shaft,could be adapted to centre and hold the artificial caput femur or anartificial caput femur surface during fixation thereof in the hip joint.

The artificial hip joint surface could further comprise an artificialacetabulum or an artificial acetabulum surface. The hole, when fittedwith the positioning shaft, could be adapted to centre and hold both theartificial caput femur or an artificial caput femur and the artificialacetabulum or an artificial acetabulum surface, during fixation thereofin the hip joint.

According to one embodiment the artificial caput femur surface comprisesa convex shape towards the centre of the hip joint, and the artificialacetabulum surface comprises a concave shape towards the centre of thehip joint. The artificial convex caput femur surface could be adapted tobe fixated to the pelvic bone of the human patient, and the artificialconcave acetabulum surface could be adapted to be fixated to the femoralbone of the human patient.

According to one embodiment the medical device could comprise apositioning shaft adapted to be placed in the hole, for centering theartificial hip joint surface, when placed in the hip joint. The at leastone artificial hip joint surface could comprise an artificial acetabulumor an artificial acetabulum surface, the positioning shaft, when fittedin said hole, could be adapted to center and hold the artificialacetabulum or the artificial acetabulum surface during fixation thereofin the hip joint.

The medical according to any of the embodiments above could comprise apositioning shaft adapted to be placed in the hole for centering theartificial hip joint surface, when placed in the hip joint. At least oneartificial hip joint surface could comprise an artificial caput femur oran artificial caput femur surface, and the positioning shaft, whenfitted in the hole, is adapted to centre and hold the artificial caputfemur or an artificial caput femur surface during fixation thereof inthe hip joint.

According to one embodiment the medical device, according to any of theembodiments above, comprises a positioning shaft adapted to be placed inthe hole for centering the at least one artificial hip joint surface,when placed in the hip joint. The artificial hip joint surface furthercomprises an artificial acetabulum or an artificial acetabulum surface,the positioning shaft, when fitted in the hole, could be adapted tocentre and hold both the artificial caput femur or the artificial caputfemur surface, and the artificial acetabulum, or an artificialacetabulum surface, during fixation thereof in the hip joint.

According to one embodiment the artificial caput femur surface comprisesa convex shape towards the centre of the hip joint, and the artificialacetabulum surface comprises a concave shape towards the centre of thehip joint. The artificial convex caput femur surface could be adapted tobe fixated to the pelvic bone of the human patient, and the artificialconcave acetabulum surface could be adapted to be fixated to the femoralbone of the human patient.

According to another embodiment of the medical device, the caput femurhave a convex hip joint surface towards the centre of the hip joint, andthe acetabulum have a concave hip joint surface towards the centre ofthe hip joint, and at least one artificial hip joint surface comprises:an artificial caput femur or an artificial caput femur surface, having aconvex shape towards the centre of the hip joint, comprising a firsthole, and an artificial acetabulum or an artificial acetabulum surface,having a concave form towards the centre of the hip joint, comprising asecond hole. The artificial caput femur or the artificial caput femursurface and the artificial acetabulum or the artificial acetabulumsurface are adapted to be centred in the hip joint by the positioningshaft placed in the hole and at least one of the femoral or pelvic bone.The artificial convex caput femur or the artificial convex caput femursurface have the first hole placed in the centre of the convex part, forenabling the positioning shaft to be introduced into the hole andcentering the artificial convex caput femur or the artificial convexcaput femur surface, when placed in the hip joint, and the artificialconcave acetabulum or the artificial concave acetabulum surface have thesecond hole placed in the centre of the concave part, for enabling thepositioning shaft to be introduced into the hole and centering theartificial concave acetabulum or the artificial concave acetabulumsurface, when placed in the hip joint.

According to one embodiment the artificial convex caput femur surface isadapted to be fixated to the pelvic bone of the human patient, and theartificial concave acetabulum surface is adapted to be fixated to thefemoral bone of the human patient.

The caput femur has a convex hip joint surface towards the centre of thehip joint, and the acetabulum, has a concave hip joint surface towardsthe centre of the hip joint. According to one embodiment the medicaldevice further comprises a positioning shaft adapted to centre theartificial hip joint surface when placed in the hole, wherein the atleast one artificial hip joint surface comprises; an artificial caputfemur or an artificial caput femur surface, having a convex form towardsthe centre of the hip joint, comprising a first hole. The artificial hipjoint surface further comprises an artificial acetabulum or anartificial acetabulum surface, having a concave form towards the centreof the hip joint, comprising a second hole. The artificial caput femuror the artificial caput femur surface and the artificial acetabulum orthe artificial acetabulum surface are adapted to be centred in the hipjoint by the positioning shaft placed in the hole and in at least oneof: the femoral bone and the pelvic bone. The artificial convex caputfemur or the artificial convex caput femur surface having the first holeplaced in the centre of the convex part, for enabling the positioningshaft to be introduced into the hole and centreing the artificial convexcaput femur or the artificial convex caput femur surface, when placed inthe hip joint, and the artificial concave acetabulum or the artificialconcave acetabulum surface having the second hole placed in the centreof the concave part, for enabling the positioning shaft to be introducedinto the hole and centreing the artificial concave acetabulum or theartificial concave acetabulum surface, when placed in the hip joint.

In one embodiment the artificial convex caput femur surface is adaptedto be fixated to the pelvic bone of the human patient, and theartificial concave acetabulum surface is adapted to be fixated to thefemoral bone of the human patient.

According to another embodiment the positioning shaft is adapted toreceive the hip joint surfaces inserted into the hip joint through thehip joint capsule and/or the pelvic bone. However it is equallyconceivable that the positioning shaft is adapted to receive the hipjoint surfaces to be mounted onto said positioning shaft, inside of thehip joint.

Method

A method of treating a hip joint of a patient is further provided. Themethod comprising the steps of: cutting the skin of the patient,dissecting an area of the hip joint, placing a positioning shaft in thehip joint, providing a medical device comprising a positioning hole,said hole being adapted to be placed and dimensioned such that themedical device is adapted to be fitted using said positioning shaft,placing said medical device at least partly surrounding said positioningshaft, fixating said medical device comprising an artificial hip jointsurface in the right position in the hip joint using said positioningshaft.

The method could further comprise the step of removing said positioningshaft.

The step of fixating the medical device in the hip joint could accordingto one embodiment comprise the step of fixating the medical device inthe hip joint using a fixation element selected from a group consistingof: at least one screw, at least one pin, at least one portion of atleast one of the parts adapted to be introduced into the other part, theparts being adapted to be sliding into the other part, form fitting,welding, adhesive, pin, wire, a ball mounted into a bowl being portionsof said parts, a male portion of one part mounted into a female portionof the other part, a key introduced into a lock being portions of saidparts, band, and other mechanical connecting members.

The step of fixating the medical device in the hip joint could comprisethe step of fixating the medical device to the caput femur or femoralbone.

The step of fixating the medical device in the hip joint could comprisethe step of fixating the medical device to the acetabulum or pelvicbone.

The step of placing a positioning shaft in the hip joint could comprisethe step of placing a positioning shaft in the caput femur or femoralbone.

The step of placing a positioning shaft in the hip joint could comprisethe step of placing a positioning shaft in the acetabulum or pelvicbone.

The step of placing the medical device at least partly surrounding saidpositioning shaft, could comprise the step of placing an artificialacetabulum or artificial acetabulum surface onto the positioning shaftin the hip joint, wherein said positioning shaft is introduced into saidhole.

The method according to any of the embodiment herein could comprise thestep of placing said medical device at least partly surrounding thepositioning shaft, which could comprise placing an artificial caputfemur or artificial caput femur surface onto the positioning shaft inthe hip joint, the positioning shaft could be introduced into the hole.

The step of placing the medical device at least partly surrounding thepositioning shaft could comprise placing an artificial acetabulum orartificial acetabulum surface onto the positioning shaft in the hipjoint, wherein the positioning shaft is introduced into said hole.

The at least one of the artificial caput femur or artificial caput femursurface and the artificial acetabulum or artificial acetabulum have athrough going hole with an inlet and an outlet. The method could furthercomprise introducing the positioning shaft into said hole inlet andpassing out from the hole outlet.

An arthroscopic method of treating a hip joint of a patient is furtherprovided. The method comprises the steps of: inserting at least oneneedle or a tube like instrument into the patient's hip joint, using theneedle or tube like instrument to fill the joint with a fluid, placingat least two arthroscopic trocars in the joint, inserting a camerathrough one of the arthroscopic trocars into the joint, dissecting anarea of the hip joint, placing a positioning shaft in the hip joint,providing a medical device comprising a positioning hole, said holebeing adapted to be placed and dimensioned such that the medical deviceis adapted to be fitted using said positioning shaft, placing saidmedical device at least partly surrounding said positioning shaft,fixating said medical device in the right position in the hip jointusing said positioning shaft.

The method could further comprise the step of removing said positioningshaft.

The step of fixating the medical device in the hip joint could accordingto one embodiment comprise the step of fixating the medical device inthe hip joint using a fixation element selected from a group consistingof: at least one screw, at least one pin, at least one portion of atleast one of the parts adapted to be introduced into the other part, theparts being adapted to be sliding into the other part, form fitting,welding, adhesive, pin, wire, a ball mounted into a bowl being portionsof said parts, a male portion of one part mounted into a female portionof the other part, a key introduced into a lock being portions of saidparts, band, and other mechanical connecting members.

The step of fixating the medical device in the hip joint could comprisethe step of fixating the medical device to the caput femur or femoralbone.

The step of fixating the medical device in the hip joint could comprisethe step of fixating the medical device to the acetabulum or pelvicbone.

The step of placing a positioning shaft in the hip joint could comprisethe step of placing a positioning shaft in the caput femur or femoralbone.

The step of placing a positioning shaft in the hip joint could comprisethe step of placing a positioning shaft in the acetabulum or pelvicbone.

The step of placing the medical device at least partly surrounding saidpositioning shaft, could comprise the step of placing an artificialacetabulum or artificial acetabulum surface onto the positioning shaftin the hip joint, wherein said positioning shaft is introduced into saidhole.

The method according to any of the embodiment herein could comprise thestep of placing said medical device at least partly surrounding thepositioning shaft, which could comprise placing an artificial caputfemur or artificial caput femur surface onto the positioning shaft inthe hip joint, the positioning shaft could be introduced into the hole.

The step of placing the medical device at least partly surrounding thepositioning shaft could comprise placing an artificial acetabulum orartificial acetabulum surface onto the positioning shaft in the hipjoint, wherein the positioning shaft is introduced into said hole.

The at least one of the artificial caput femur or artificial caput femursurface and the artificial acetabulum or artificial acetabulum have athrough going hole with an inlet and an outlet. The method could furthercomprise introducing the positioning shaft into said hole inlet andpassing out from the hole outlet.

Please note that any embodiment or part of embodiment, feature, method,associated system, part of system described herein may be combined inany way. Please note that the description in general should be seen asdescribing both of an apparatus and a method.

BRIEF DESCRIPTION OF DRAWINGS

The invention is now described, by way of example, with reference to theaccompanying drawings, in which:

FIG. 1 a shows the hip joint in section,

FIG. 1 b shows the collum femur in section having cancellous bone andcortical bone,

FIG. 2 shows the human patient in a frontal view when incisions arebeing made in the abdominal region,

FIG. 3 shows the human patient in a frontal view when incisions arebeing made in the abdominal region,

FIG. 4 shows a lateral view of a human patient,

FIG. 5 shows a lateral view of a human patient when the femoral bonedissected,

FIG. 6 shows a lateral view of the human patient when a positioningshaft is being placed in the caput and collum femur,

FIG. 7 shows the step of creating a hole in the caput and collum femur,

FIG. 8 a shows the placing of a positioning shaft in the caput femur andcollum femur,

FIG. 8 b shows the placing of a medical device onto the caput femurusing the positioning shaft,

FIG. 9 shows the process of placing an artificial caput femur surfaceonto the caput femur, through a hole in the pelvic bone,

FIG. 10 shows the process of placing an artificial caput femur surfaceonto the caput femur, through a hole in the pelvic bone,

FIG. 11 shows the removal of the positioning shaft,

FIG. 12 shows the placing of an artificial caput femur surface onto thecaput femur,

FIG. 13 shows the placing of an artificial caput femur surface onto thecaput femur,

FIG. 14 shows the removal of the positioning shaft,

FIG. 15 shows the placing of adhesive on a section of a surface of thecollum femur,

FIG. 16 shows the placing of a medical device inside the hip jointthrough a hole in the pelvic bone,

FIG. 17 shows the hip joint in section when a medical device is beingfixated,

FIG. 18 shows the placing of a prosthetic part in the hole of the pelvicbone,

FIG. 19 shows a lateral view of the human patient when an instrument forcreating a hole in the pelvic bone is provided,

FIG. 20 shows different instruments possible to place on a forcetransferring member,

FIG. 21 shows the hip joint in section when a hole in the pelvic bone isbeing created,

FIG. 22 shows the hip joint in section when a hole in the pelvic bone isbeing created,

FIG. 23 shows the hip joint in section when the caput femur is beingreamed,

FIG. 24 a-c shows the an expandable reamer,

FIG. 25 shows the hip joint in section when an artificial caput femursurface is being provided,

FIG. 26 shows the creation of a hole in the pelvic bone from theopposite side from acetabulum,

FIG. 27 shows the hip joint in section when a hole in the pelvic bone isbeing created,

FIG. 28 shows the hip joint in section when the caput femur is beingsurgically modified,

FIG. 29 shows the hip joint in section when a concave surface id createdin the collum femur and caput femur,

FIG. 30 shows the injecting of an adhesive in the concave surface in thecaput femur and collum femur,

FIG. 31 shows the positioning of a medical device in the collum femurand caput femur through a hole in the pelvic bone,

FIG. 32 shows the placing of a medical device through a hole in thepelvic bone,

FIG. 33 shows the placing of a prosthetic part in the hole in the pelvicbone,

FIG. 34 shows the fixation of a prosthetic part in the hole in thepelvic bone,

FIG. 35 a shows a medical device in a schematic view,

FIG. 35 b shows a medical device in section,

FIG. 36 a shows the placing of a band onto a medical device,

FIG. 36 b shows the femoral bone when a medical device has been placedon the caput femur,

FIG. 37 shows an embodiment of a medical device,

FIGS. 38 a-e shows a medical device in an operable embodiment,

FIG. 39 a shows a medical device in an expandable embodiment, in a firststate,

FIG. 39 b shows a medical device in an expandable embodiment, in asecond state,

FIG. 40 a shows the medical device in an embodiment where the medicaldevice comprises multiple parts,

FIG. 40 b shows the medical device in an embodiment where the medicaldevice comprises multiple parts, in greater detail,

FIG. 40 c shows the medical device in an embodiment where the medicaldevice comprises multiple parts, when assembled,

FIG. 41 shows an artificial acetabulum surface according to oneembodiment,

FIG. 42 a shows the femoral bone when a medical device is being placedon the caput femur,

FIG. 42 b shows the femoral bone when a medical device is being placedon the caput femur, in a top view,

FIG. 43 a,b shows an instrument for placing positioning shafts in thecaput femur and collum femur,

FIG. 44 a shows the placing of a prosthetic part in the hole in thepelvic bone,

FIG. 44 b shows the operation of the prosthetic part in the hole in thepelvic bone,

FIG. 45 shows hip joint in section when a prosthetic part is beingplaced,

FIG. 46 shows the hip joint in section when a bone plug or medicaldevice is being fixated,

FIG. 47 shows the hip joint in section when a bone plug is beingprovided,

FIG. 48 shows the removal of the positioning shaft from the hip joint,

FIG. 49 shows a prosthetic part, in further detail,

FIG. 50 shows injecting members injecting material into the holes in thefemoral bone and the pelvic bone,

FIG. 51 shows an implantable lubricating system,

FIG. 52 a shows a frontal view of the human patient when sutures orstaplers are being provided,

FIG. 52 b shows a frontal view of the human patient when sutures orstaplers are being provided,

DETAILED DESCRIPTION

Biocompatible material is to be understood as being a material with lowlevel of immune response. Biocompatible materials are sometimes alsoreferred to as biomaterials. Analogous is biocompatible metals abiocompatible metal with low immune response such as titanium ortantalum. The biocompatible metal could also be a biocompatible alloycomprising at least one biocompatible metal.

A metal alloy is to be understood as a mixture of two or more elementsin solid solution in which the major component is a metal. A steel alloyis hence an alloy wherein one of the components is steel which in turnis an alloy of iron and carbon. A titanium alloy is hence an alloywherein one of the components is titanium.

Elasticity is to be understood as a materials ability to deform in anelastic way.

Carrying surface and weight carrying surface is to be understood as asurface adapted to carry weight inside of the hip joint.

Form fitting is to be understood as an element having a part or sectionwhich is adapted to enable a mechanical connection of said element to atleast one other element using said part or section. Form fittedstructure is a structure of an element which enables form fitting.

Functional hip movements are to be understood as movements of the hipthat at least partly correspond to the natural movements of the hip. Onsome occasions the natural movements of the hip joint might be somewhatlimited or altered after hip joint surgery, which makes the functionalhip movements of a hip joint with artificial surfaces somewhat differentthan the functional hip movements of a natural hip joint.

The functional position of an implantable medical device or prosthesisis the position in which the hip joint can perform functional hipmovements.

Functional hip joint is a hip joint that can perform functional hipmovements either with or without an implanted medical device orprosthesis.

Connection line is to be understood as a line of the connecting surfaceof at least two medical device parts connecting to each other.

In the following a detailed description of preferred embodiments of thepresent invention will be given. In the drawing figures, like referencenumerals designate identical or corresponding elements throughout theseveral figures. It will be appreciated that these figures are forillustration only and are not in any way restricting the scope of theinvention. Thus, any references to direction, such as “up” or “down”,are only referring to the directions shown in the figures. Also, anydimensions etc. shown in the figures are for illustration purposes.

The medical device according to any of the embodiments could comprise atleast one material selected from a group consisting of:polytetrafluoroethylene (PTFE), perfluoroalkoxy (PFA) and fluorinatedethylene propylene (FEP). It is furthermore conceivable that thematerial comprises a metal alloy, such as cobalt-chromium-molybdenum ortitanium or stainless steel, or polyethylene, such as cross-linkedpolyethylene or gas sterilized polyethylene. The use of ceramic materialis also conceivable, in the contacting surfaces or the entire medicaldevice such as zirconium or zirconium dioxide ceramics or aluminaceramics. The part of the medical device in contact with human bone forfixation of the medical device to human bone could comprise a poorhousestructure which could be a porous micro or nano-structure adapted topromote the growth-in of human bone in the medical device for fixatingthe medical device. The porous structure could be achieved by applying ahydroxy-apatite (HA) coating, or a rough open-pored titanium coating,which could be produced by air plasma spraying, a combination comprisinga rough open-pored titanium coating and a HA top layer is alsoconceivable. The contacting parts could be made of a self lubricatedmaterial such as a waxy polymer, such as PTFE, PFA, FEP, PE and UHMWPE,or a powder metallurgy material which could be infused with a lubricant,which preferably is a biocompatible lubricant such as a Hyaluronic acidderivate. It is also conceivable that the material of contacting partsor surfaces of the medical device herein is adapted to be constantly orintermittently lubricated. According to some embodiments the parts orportions of the medical device could comprise a combination of metalmaterials and/or carbon fibers and/or boron, a combination of metal andplastic materials, a combination of metal and carbon based material, acombination of carbon and plastic based material, a combination offlexible and stiff materials, a combination of elastic and less elasticmaterials, Corian or acrylic polymers.

FIG. 1 a shows the hip joint of a human patient in section. The hipjoint comprises a caput femur 5 placed at the very top of collum femur 6which is the top part of the femur bone 7.

The caput femur 5 is in connection with the acetabulum 8 which is a bowlshaped part of the pelvic bone 9. Both the caput femur surface 10 andthe acetabulum surface 11 is covered with articular cartilage 13 whichacts as a cushion in the hip joint. In patients with hip jointosteoarthritis, this articular cartilage 13 is abnormally worn down dueto a low grade inflammation. The hip joint is surrounded by the hipjoint capsule 12 which provides support for the joint and hindersluxation. After conventional hip joint surgery, penetrating the hipjoint capsule 12, the capsule 12 is dramatically weakened due to thelimited healing possibilities of its ligament tissue. By performing hipjoint surgery without damaging the hip joint capsule 12, the patient canfully recover and place equal amount of strain on an artificial joint asis possible on a natural one.

FIG. 1 b shows the collum femur 6 in section. Both caput femur 5 andcollum femur 6 further comprises cortical bone 601, the outer moresclerotic bone, and cancellous bone 602, placed in the bone marrow 603.The cortical bone is much more dense and beneficial to anchor aprosthesis two, or to place a positioning shaft in, whereas thecancellous bone 602 provides stability in the bone due to its sandwichconstruction, but is easy to remove to make room for a fixation memberof a prosthesis.

FIG. 2 shows a frontal view of the body of a human patient. A surgicalmethod of operating the hip joint from the opposite side fromacetabulum, is according to a first embodiment performed starting withan incision 1 in the abdominal wall of the human patient. The incision 1passes through the abdominal muscles in to the abdomen of the humanpatent. In a second embodiment the incision 2 is conducted through theabdominal muscles and in to the pelvic area, below peritoneum. Accordingto a third embodiment the incision 3 is performed just between Illiumand the surrounding tissue, an incision 3 which could enable the pelvicbone to be dissected with very little penetration of fascia and musculartissue. According to a fourth embodiment the incision 4 is made in theinguinal channel. In all of the four embodiments the tissue surroundingthe pelvic bone 9 in the area opposite to acetabulum is removed orpenetrated which enables the surgeon to reach the pelvic bone 9.

FIG. 3 shows a frontal view of the body of a human patient. Alaparoscopic/arthroscopic method of operating the hip joint, from theopposite side from acetabulum, is according to a first embodimentperformed starting with making small incisions 14 in the abdominal wallof the human patient. The small incisions enable the surgeon to insertlaparoscopic trocars into the abdomen of the human patient. According tothe first embodiment the incisions 14 passes through the abdominal wall,in to the abdomen of the human patent. According to a second embodimentthe small incisions 15 is conducted through the abdominal wall, in tothe pelvic area, below peritoneum. According to a third embodiment thesmall incisions 16 is performed just between Illium and the surroundingtissue, an incision 16 which could enable the pelvic bone to bedissected with very little penetration of fascia and muscular tissue.According to a fourth embodiment the incision 17 is made in the inguinalchannel. In all of the four embodiments the tissue surrounding thepelvic bone 9 in the area opposite to acetabulum 8 is removed orpenetrated which enables the surgeon to reach the pelvic bone 9.

FIG. 4 shows a lateral view of a conventional hip joint surgery where anincision 112 is made in the thigh 113 enabling the surgeon to reach thefemur bone 7 on which the caput femur 5 is located. In a conventionalhip joint surgery the hip joint is accessed through the hip jointcapsule, which forces the surgeon to, at least partly, savage thestructure of the capsule.

FIG. 5 to enable the surgeon to reach the caput femur 5 the femoral bone7 comprising the caput femur 5 is placed outside of the hip jointcapsule 12. The surgeon can thereby perform surgical modifications onthe caput femur including fixating holding members or prosthetic partsto the surface or the bone structure of any part of the femoral bone 7.

FIG. 6 shows the placing of a positioning shaft 900 in the caput femur 5and collum femur 6, penetrating the surface and the cortical bone of thecaput femur 5. For example the positioning shaft can be fixated to thebone structure of the femoral bone 7 the collum femur 6 or the caputfemur 5 using mechanical fixating members, adhesive, a threaded sectionof the positioning shaft 900 or using an expanding part or section ofthe positioning shaft 900.

FIG. 7 shows the femoral bone 7, comprising the collum femur 6 and thecaput femur 5, when a hole 902 going through the surface and thecortical bone of the caput femur 5 and in to the cancellous bone of thecaput femur 5 and collum femur 6. The hole 902 is created using a drill901, which could be powered using an operation device or through manualforce.

FIG. 8 a shows the placing of a positioning shaft 900 in the hole 902 inthe surface of the caput femur 5 the cortical bone of the caput femur 5and the cancellous bone of the collum femur 6. For example thepositioning shaft 900 can be fixated to the bone structure of thefemoral bone 7 the collum femur 6 or the caput femur 5 using mechanicalfixating members, adhesive, a threaded section of the positioning shaft900 or using an expanding part or section of the positioning shaft 900.

FIG. 8 b shows the step of placing an artificial caput femur surface 45on the caput femur 5 using the positioning shaft 900. The artificialcaput femur surface 45 comprises a hole adapted to encircle thepositioning shaft 900 such that the positioning shaft 900 positions andcenters the artificial caput femur surface 45 in a suitable position onthe caput femur 5.

FIG. 9 shows the hip joint in section, when an artificial caput femursurface 45 is positioned on the caput femur using a positioning shaft900 placed in a hole 902 in the caput femur 5 and collum femur 6. Thecaput femur 5 is according to this embodiment inserted through a hole 18in the pelvic bone 9 from the opposite side from acetabulum 8, whichalso is the way the positioning shaft 900 has been inserted in the caputfemur 5 and collum femur 6. To enable the artificial caput femur to beinserted through a hole 18 in the pelvic bone 9 having a diameter d1smaller than the diameter d2 required for the artificial caput femursurface 45 to reach over the caput femur 5. The artificial caput femursurface 45 therefore comprises elastic material which enables theartificial caput femur surface 45 to in a first state have a firstdiameter d1, for passing through the hole 18 in the pelvic bone 9, andin a second state have a second diameter d2 for reaching over the caputfemur 5, and in a third state have a third diameter d3 for clasping thecaput femur 5, thereby creating a stable position inside the hip joint.The artificial caput femur surface comprises a hole adapted to encirclethe positioning shaft 900 for positioning and centering the artificialcaput femur surface 45 inside the hip joint.

FIG. 10 shows the step of inserting an artificial acetabulum surface 65through the hole 18 in the pelvic bone 9 using a positioning shaft 900placed in a hole 902 in the caput femur 5 and the collum femur 6. Thepositioning shaft 900 assists in the positioning and centering of theartificial caput femur surface 45 to the caput femur 5 in the hip joint.To enable the insertion of the artificial caput femur surface 45 througha hole 18 in the pelvic bone 9 the size of the artificial caput femursurface 45 is adapted to be changed. In a first state for inserting theartificial caput femur surface 45 through a hole 18 in the pelvic bone 9the artificial caput femur surface 45 has a largest diameter d1, smallerthan the diameter of the hole 18 in the pelvic bone 9.

FIG. 11 shows the removal of the positioning shaft 900 from the hole 902in the caput femur 5, after the placing of the artificial acetabulumsurface 65. After the artificial acetabulum surface 65 has passedthrough the hole 18 in the pelvic bone 9 the surface is expanded torepresent the entire contacting surface of the acetabulum 8, and thelargest diameter is now d2 which confines the artificial acetabulumsurface inside of the hip joint. The use of the positioning shaft 900also ensures the correct centering of the caput femur surface 45 inrelation to the artificial acetabulum surface 65 inside of the hipjoint.

FIGS. 12-14 shows the process of placing an artificial caput femursurface 45 on the caput femur 5 in the hip joint through a hole 18 inthe pelvic bone 9. The artificial caput femur surface 45 is insertedthrough the hole 18 in the pelvic bone 9 in its folded state, as shownin FIG. 12, positioned, guided and centered by the positioning shaft 900fixated to the caput femur 5 and the collum femur 45. After the passingof the hole 18 in the pelvic bone 9 the artificial caput femur surface45 is expanded as shown in FIG. 13 and eventually clasps the caput femur5 as shown in FIG. 14, whereafter the positioning shaft 900 is removed,as shown in FIG. 14.

An alternative embodiment of fixation of a medical device comprising anartificial caput femur will now be described with reference to FIGS.15-18.

FIG. 15 shows the hip joint in section in a step in which the caputfemur 5 has been removed and a surface of the section 610 in the collumfemur 6 is being prepared for the fixation of an artificial caput femur600. An injecting member 613 applies and adhesive 614 to the surface ofthe section 610 of the collum femur 6. The injecting member 613 isadapted to be introduced through a hole 18 in the pelvic bone 9 and toapply the adhesive 614 which was contained within the injecting member613. Furthermore a positioning shaft 900 is placed in the collum femur 6from the hole 18 in the pelvic bone 9. The positioning shaft ispreferably fixated to the cortical bone of the femoral bone 7 as well asthe cancellous bone of the collum femur 6.

FIG. 16 shows the step of introducing and fixating the medical device600 to the collum femur 6, through a hole 18 in the pelvic bone 9. Thestabilizing member 612 is adapted to stabilize the medical device 600from the outside of the collum femur 6 substantially perpendicular tothe longitudinal extension of the collum femur 6, and from theacetabulum side, substantially in line with the longitudinal extensionof the collum femur 6 through the stabilizing member 612 being placed incontact with the outside of the collum femur 6 and the surface of thesection 610 in the collum femur 6. The stabilizing member 612 is fixatedto the outside of the collum femur 6 and/or to the surface of thesection 610 in the collum femur 6 by means of the adhesive 614. Howeverthe adhesive 614 could be replaced or assisted by bone cement or amechanical fixation element 615. The medical device 600 is positioned,guided and centered a positioning shaft 900 placed in the collum femur 6from the hole 18 in the pelvic bone 9. The positioning shaft 900 ispreferably fixated to the cortical bone of the femoral bone 7 as well asthe cancellous bone of the collum femur 6.

FIG. 17 shows the hip joint in section when the medical device 600 ispositioned on the collum femur 6. The stabilizing member 612 is herefixated to the collum femur 6 by means of adhesive 614 and a mechanicalfixation element 615, such as a screw or pin.

FIG. 18 shows the hip joint in section when the medical device 600 ispositioned on the collum femur 6. The stabilizing member 612 is herefixated to the collum femur by means of adhesive 614. A prosthetic part98 comprising an artificial acetabulum surface 618 has been positionedin the hole 18 in the pelvic bone 9. The artificial acetabulum surface618 is adapted to be in direct of indirect connection with theartificial caput femur surface 607. In embodiments where the artificialacetabulum surface 618 is adapted to be in indirect connection with theartificial caput femur surface 607 a lubricating fluid or a lubricatingmaterial (not shown) can be placed between said artificial acetabulumsurface 618 and said artificial caput femur surface 607. The prostheticpart 98 is adapted to carry the load placed on the artificial acetabulumsurface 618 from weight of the human patient through the contact withthe artificial caput femur surface 607 by means of the supportingmembers 99. The prosthetic part 98 can further be fixated to the pelvicbone 9 by means of bone cement, adhesive, screws, form fitting, welding,sprints, band or some other mechanical connecting member. According tothis embodiment the supporting members 99 are positioned on theacetabulum side of the pelvic bone 9, however it is also conceivablethat the supporting members 99 are positioned on the abdominal side ofthe pelvic bone 9. The supporting means could be constructed in manydifferent ways and this should be seen as examples.

An alternative method of creating a hole in the pelvic bone, preparingthe surfaces of the caput femur and the acetabulum, inserting thepositioning shaft and inserting and fixating artificial hip jointsurface parts will now be described with reference to FIGS. 19-23.

FIG. 19 shows a human patient in section when an incision 1 is made inthe abdominal wall of the human patient, and a second incision 200 inmade in the lateral part of the left thigh. A drilling member 201 hasbeen introduced through the incision 200 in the thigh, penetrating thefascia lata, and reaching the femoral bone 7. After the drilling member201 has made contact with the femoral bone 7, a drilling process isstarted which creates a hole 205 in the cortical bone of the femoralbone 7 and into the cancellous bone of the femoral bone 7, the hole 205then propagates along a length axis of the collum femur 6 and eventuallyreaches the caput femur 5, from the inside thereof. The caput femur 5 ispenetrated from the inside and the drilling member 201 continues to theacetabulum 8 which is a bowled shaped part of the pelvic bone 9. Thedrilling member 201 penetrates the pelvic bone 9 and continues into theabdominal area of the human patient. The drilling member 201 is thenretracted from the hole 205 which leaves a hole 201 reaching from thelateral side of the thigh, to the area of the hip joint. The drillingmember 201 is powered by an operating device 202 which could be anelectrically, hydraulically or pneumatically powered operating device202.

After the hole 205 has been created along a length axis of the collumfemur 6, a force transferring member 206 is inserted through the hole205. The force transferring member could be a tubular or solid shaft, ora flexible member such as a wire.

FIG. 20 shows the hip joint in section when a force transferring member206 has been inserted through the hole 205. The force transferringmember 206 comprises a tool fixating member 218 positioned on the end ofthe force transferring member 206. The tool fixating member 218 couldcomprise a screw-thread or a bayonet joint which could be activated tofixate a tool 224,225,226 to the force transferring member 206, by theturning of said force transferring member by means of manualmanipulation or an operating device 207. FIG. 5 further shows a tool forcreating a hole 224 in the pelvic bone 9, a tool 225 for manipulating animplantable device such as a prosthesis or a prosthetic part, and a tool226 for reaming the acetabulum 8 and/or the caput femur 5. The toolscomprise a fixating member 219 which acts together with the toolfixating member 218 on the force transferring member 206 to fixate thetool 224,225,226 to the force transferring member 206. The tools224,225,226 is inserted through the incision in the abdominal region, asshown in FIG. 4. where a tool 224 for creating a hole in the pelvic bone9 is inserted through an incision 1 in the abdominal region of the humanpatient using a tool introducing member 203. The force transferringmember 206 according to any of the embodiments could be used as apositioning shaft, for positioning, centering and guiding a tool or amedical device, such as a prosthetic part.

FIG. 21 shows the hip joint in section when a tool 224 for creating ahole 18 b in the pelvic bone is fixated to the tool fixating member 219on the force transferring member 206. When the tool 224 for creating ahole in the pelvic bone 9 is applied to the force transferring member206, the force transferring member 206 is preferably operated using anoperating device 207, which could be an electrical, hydraulic orpneumatic operating device. The tool for creating a hole in the pelvicbone 9 comprises a bone contacting organ 22 which is adapted to createthe hole 18 b in the pelvic bone 9 through a sawing, drilling or millingprocess powered by a rotating, vibrating or oscillating movement of theforce transferring member 206.

FIG. 22 shows the hip joint in section when the hole 18 b in the pelvicbone 9 has been created. According to the embodiment shown the hole 18 bis created through the creation of a bone plug 207 which can be adaptedto be replaced after the steps of the operation performed through thehole 18 b in the pelvic bone 9 has been concluded.

FIG. 23 shows the reaming of the acetabulum 8 and/or the caput femur 5using a reamer 226 comprising reaming blades 40. The reamer 226 isadapted to be introduced through the pelvic bone 9 through an incisionas shown in FIG. 2. The reamer 226 is operated through manualmanipulation or an operating device 207.

FIG. 24 a shows the reamer 226 according to an embodiment where thereamer 226 is adapted to be expandable. The reaming blades 42 arefolded, which facilitates the introduction of the reamer 226 through thehole 18 b in the pelvic bone 9.

FIG. 24 b shows the expandable reamer in its reaming state with thereaming blades 40 unfolded. The reaming blades 40 comprises an abrasivematerial which removes material, shapes and smoothens the surface of theacetabulum 8 and/or the caput femur 5. 41 a denotes the abrasivematerial on the outside of the reaming blade 40, adapted to ream theacetabulum 8 surface.

FIG. 24 c shows the expandable reamer from the inside thereof, with thereaming blades 40 and the abrasive material 41 b adapted to ream thecaput femur 5.

After the surfaces of the caput femur 5 and/or the acetabulum 8 has beenprepared the step of providing the surfaces with an artificialacetabulum surface 65 and/or an artificial caput femur surface 65 isperformed.

FIG. 25 shows the step of providing an artificial caput femur surface 45which is inserted through the incision according to FIG. 2 or FIG. 3.The artificial caput femur surface 45 is then mounted on to the forcetransferring member 206 which acts a guide for the surface 45,facilitating the introduction and fixation of said surface 45. Howeverit is furthermore conceivable that the force transferring member 206 isreplaced by a positioning shaft according to any of the embodimentsdescribed herein, adapted to position, center or guide the artificialcaput femur surface 45 on to the caput femur 5.

An alternative way of providing an artificial hip joint surface to asurgically modified caput femur will now be described, with reference toFIGS. 26-34

FIG. 26 shows a lateral view of a human patient where a surgicalinstrument 35 adapted to create a hole 18 in the pelvic bone 9 from theabdominal side of the pelvic bone 9 is inserted through an incision inthe abdominal wall. The surgical instrument could comprises a flexiblepart or section 300, enabling the surgical instrument to be veryprecisely adjusted to reach the pelvic bone 9 or the hip joint from theabdominal side of the pelvic bone 9. The stiffness of said flexible partor section 300 could range from completely flexible to completely stiffto fit the surroundings of the particular operation. The surgicalinstrument 35 could be powered through an operating device which in turncould comprise an electrical, hydraulic, mechanical, pneumatic ormagnetic engine and it could be adapted to create a rotating,oscillating, vibrating or repetitive movement.

FIG. 27 shows a hip joint in section wherein a surgical instrument 35adapted to create a hole 18 in the pelvic bone 9 is adapted to create abone plug 31. The bone plug 31 could be adapted to be replaced into saidhole 18 after the surgical or laparoscopic steps performed in the hipjoint has been concluded.

FIG. 28 shows a hip joint in section wherein a surgical instrument 604for removing the caput femur 5 is provided through a hole 18 in thepelvic bone 9. The surgical instrument comprises a sawing member 605adapted to separate the caput femur 5 from the collum femur 6. Thesurgical instrument is powered through a force transferring member 21which transfers force from an operation device or manual manipulation.

FIG. 29 shows the hip joint in section when the method of supplying amedical device is conducted according to another embodiment. Theproximal part of the caput femur has been removed by the surgicalinstrument comprising a sawing member 605. A reaming member 40 adaptedto create a concave surface 103 in the caput femur 5 is here applied toa force transferring member 206 which is inserted through a hole 205going from the lateral side of the thigh, penetrating the cortical boneof the femoral bone 7 propagating along a length axis of the collumfemur 6 in the cancellous bone and entering the area of the hip joint.The force transferring member 206 is operated using an operating device207 which could be an electrically powered operating device, ahydraulically powered operating device or a pneumatically poweredoperating device. The reamer 40 is inserted into the body of the patientthrough an incision and placed in the hip joint through a hole 18 in thepelvic bone 9. The reaming in the caput femur and part of the collumfemur 6 is mainly performed in the cancellous bone, however that doesnot exclude the possibility the some of the reaming needs to beperformed in the cortical bone of the caput femur 5 or the collum femur6.

FIG. 30 shows the step of applying an adhesive 106 to the concavesurface created by the reamer 40. The adhesive 106 is applied by aninjecting member 104 comprising an injecting nozzle 105. The adhesive106 is preferably a biocompatible adhesive such as bone cement. Theinjecting member 104 is in this embodiment adapted for introductionthrough a hole 18 in the pelvic bone 9, through the injecting member 104being bent.

FIG. 16 shows the step of providing a medical device 109 comprising anartificial concave hip joint surface 110. The medical device isaccording to this embodiment provided with a hole 905 positioned alongthe length axis of the collum femur 6. The medical device 109 is,through the hole 905, adapted to be guided by the positioning shaft 900placed in the hole 902 along a length axis of the collum femur 6. Theinsertion of the medical device 109 into the hip joint while thepositioning shaft 900 runs through the hole 905 of the medical device109 facilitates the positioning of the medical device 109 and ensuresthat the different parts of the medical device 109 is centred forfunctioning as a unit. In the embodiment shown in FIG. 31 the medicaldevice 109 is inserted into the hip joint as a single unit, however itis equally conceivable that the medical device 109 is inserted in parts(not shown) which are then connected to form the medical device 109after implantation in the patient. The artificial concave hip jointsurface 110 is fixated to the concave surface 103 created in the caputfemur 5 and collum femur 6. The medical device 109 comprises a fixationsupport 111 adapted to anchor said artificial concave hip joint surface110, to at least one of the caput femur 5 and the collum femur 6. Themedical device 109 is adapted to be introduced to the hip joint througha hole 18 in the pelvic bone 9 using a manipulation device 122comprising a gripping member 123. According to this embodiment themanipulation device 122 is bent and thereby adapted to operate through ahole 18 in the pelvic bone 9. According to one embodiment the medicaldevice 109 comprises a self lubricating material such as PTFE, howeverit is also conceivable that said medical device comprises: titanium,stainless steel, corian, PE, or other acrylic polymers, in which casethe medical device could be adapted to be lubricated after insertion inthe hip joint.

FIG. 32 shows the hip joint in section when the artificial convex hipjoint surface is fixated in the medical device 109 comprising a concavehip joint surface 110, the medical device 109 is positioned using thepositioning shaft 900. The convex hip joint surface 112 is secured inplace by the locking element 116 which is fixated to the caput femur 5using screws 121, the convex hip joint surface is guided using thepositioning shaft 900. The surface of the locking element 116 and theconcave hip joint surface 110 is placed in connection with the convexhip joint surface 112 and could be made of a friction reducing materialsuch as PTFE or a self lubricating powder material. However it is alsoconceivable that the connecting surfaces are lubricated using animplantable lubrication system adapted to lubricate the medical deviceafter said medical device has been implanted in the human patient. Thepositioning shaft 900 assists in the centering of at least oneartificial hip joint surface inside of the hip joint. According to theembodiment shown in FIG. 32 the positioning shaft 900 is insertedthrough the femoral bone 7, however according to other embodiments, thepositioning shaft is positioned inside of the hip joint from theacetabulum side.

FIG. 33 shows the placing of a prosthetic part 118 adapted to occupy thehole 18 created in the pelvic bone 9. The prosthetic part 118 comprisessupporting members 119 adapted to be in contact with the pelvic bone 9and assist in the carrying of the load placed on the medical device fromthe weight of the human patient. Furthermore FIG. 33 shows the fixationof a nut 120 to the medical device, which in turn is guided by thepositioning shaft 900.

FIG. 34 shows the hip joint in section when all the elements of themedical device has been fixated in the area of the hip joint or itssurroundings. The prosthetic part 118 adapted to occupy the hole 18 inthe pelvic bone 9 is here fixated with screws 121, however these screws121 could be assisted or replaced by an adhesive which could be appliedto the surface between the prosthetic part and the pelvic bone 9. Thepositioning shaft 900 has been refracted through the incision in thethigh.

FIG. 35 a shows a schematic view of an artificial hip joint surfacecomprising a beyond part 62, being a part passing beyond the maximumdiameter 61 of the artificial hip joint surface, thereby allowing anopening in the hip joint surface 52 to have a diameter smaller than themaximum diameter of the artificial hip joint surface.

FIG. 35 b shows an artificial hip joint surface according to anembodiment where the artificial hip joint surface comprises an innersurface 906, and an outer surface 907. The inner surface has a firstpoint 908 a, a second point 909 a, a third point 908 b, a fourth point909 b, a fifth point 908 c, and a sixth point 909 c, all points locatedon different places along a length axis L of said inner surface 906,wherein: a first straight line 910 a, reaching from said first point 908a to said second point 909 a is parallel to a second straight line 910 breaching from said third point 908 b to said fourth point 909 b, whichin turn is parallel to a third straight line 910 c reaching from saidfifth point 908 c to said sixth point 909 c, wherein: said first andsaid third straight lines 910 a, 910 c are of equal length, and whereinsaid second straight line 910 b is longer than said first 910 a and saidthird 910 c straight lines and positioned between said first 910 a andsaid third 910 c straight lines. The artificial hip joint surface isthereby passing beyond the maximum diameter of the of the artificial hipjoint surface, which enables the artificial hip joint surface to claspan element such as the caput femur 5, an artificial caput femur surfaceor an artificial replacement for the caput femur.

FIG. 36 a shows an artificial caput femur surface 45 according to anembodiment where the artificial caput femur surface is made of anexpandable structure comprising multiple slits 911 adapted to enable themounting of the artificial caput femur surface 45 on a caput femurhaving a largest diameter larger than the opening 52 of the artificialcaput femur 45. The artificial caput femur 45 is adapted to be securedusing a band 59 comprising a self locking element 60. The band 59 isadapted to encircle the artificial caput femur at the base of theartificial caput femur and to be confined by holding members 50 at thebase of the artificial caput femur surface. The artificial caput femursurface 45 further comprises a positioning hole 910 adapted to surrounda positioning shaft 900 adapted to guide, position and center theartificial caput femur surface 45.

FIG. 36 b shows the femoral bone 7 when the artificial caput femursurface 45 as shown in FIG. 36 a has been placed on the caput femur 5,and has been secured by means of the band 60. Encircling the base of theartificial caput femur surface 45. The positioning shaft 900 is placedthrough the positioning hole 910 of the artificial caput femur surface45, and the artificial caput femur surface is thereby guided, positionedand centered onto the caput femur.

FIG. 37 shows an artificial caput femur surface 45 comprising apositioning hole 910 placed centrally in the artificial caput femursurface 45. The artificial caput femur surface comprises multipleelastic arms 50 adapted to clasp the caput femur 5. The multiple elasticarms 50 have a maximum diameter 51 which is larger than the opening 52of the artificial caput femur surface 45, which enables the artificialcaput femur surface 45 to clasp the caput femur 5.

FIGS. 38 a,b,c,d,e shows the artificial caput femur surface 45 accordingto an embodiment, in which the artificial caput femur surface 45comprises a first 53 a and a second 53 b section, as shown in FIG. 38 b.The first and second sections 53 a,b are displaceable in relation toeach other. According to a first embodiment, the first section 53 a canbe rotated in relation to the second section 53 b, such that the secondsection 53 b travels underneath the first section 53 a to create adisplaced artificial caput femur surface 54, as shown in FIG. 38 c,which is possible to insert into a hip joint of a human patient througha hole 18 being oval, or at least having an area smaller than the crosssectional area of the artificial caput femur surface 45 when in its fullfunctional size 45, as shown in FIG. 38 a. According to this embodimentthe two sections are connected to each other when the artificial caputfemur surface 45 is returned to its full functional size using amechanical form fitting 55, as shown in FIG. 38 e. However it is alsoconceivable that the connection is assisted or replaced with screws,welding, sprints, band, adhesive or some other mechanical connectingmember. The artificial caput femur surface further comprises apositioning hole 910 centrally placed in the artificial caput femursurface 45, and adapted to encircle a positioning shaft 900.

FIG. 39 a,b shows the artificial caput femur surface 45 according to anembodiment, in which said artificial caput femur surface 45 comprisesfour slits. The artificial caput femur surface 45 is flexible in itsconstruction allowing the four artificial caput femur arms 50 to befolded towards the center axis of the artificial caput femur surface 45thus allowing the artificial caput femur surface 45 to be inserted intoa hip joint through a hole smaller than the full functional size of theartificial caput femur surface 45. The artificial caput femur surface 45according to this embodiment can be constructed to go beyond the maximumdiameter of the caput femur 5, in which case the construction with theslits 49 allows the artificial caput femur surface 45 to change to botha smaller and a larger size than said full functional size. Theartificial caput femur surface 45 further comprises a positioning hole910 centrally placed in the artificial caput femur surface 45, andadapted to encircle a positioning shaft 900.

FIG. 39 b shows the artificial caput femur surface 45 in section whensaid artificial caput femur surface arms 50 are folded for insertionthrough a hole 18 with an area smaller than the largest area of theartificial caput femur surface 45 when in its full functional size.

FIG. 40 a,b,c shows the artificial caput femur surface 45 according toan embodiment, in which the artificial caput femur surface 45 comprisesmultiple artificial caput femur surface parts 46. The multipleartificial caput femur surface parts 46 are adapted to be connected toan interconnecting artificial caput femur surface part 56 afterinsertion into a hip joint. The interconnecting artificial caput femursurface part 56 comprises self locking connecting members 57, shown inFIG. 40 b, that fits with corresponding self locking members 58 of theartificial caput femur surface parts 46. The artificial caput femursurface parts 46 create an artificial caput femur surface 45 whenconnected to each other, shown in FIG. 40 c. The self locking members57, 58 can be assisted or replaced with screws, welding, sprints, band,adhesive or some other mechanical connecting member. The artificialcaput femur surface 45 according to this embodiment can further beadapted to go beyond the maximum diameter of the caput femur 5. Theartificial caput femur surface 45 further comprises a positioning hole910 centrally placed in the artificial caput femur surface 45, andadapted to encircle a positioning shaft 900.

The embodiments above have been discussed in relation to an artificialcaput femur surface, however it is equally conceivable that thetechnical solutions presented in the embodiments are used for artificialacetabulum surfaces, which can be used on their own or in connectionwith an artificial caput femur surface.

FIG. 41 shows an artificial acetabulum surface 65 according to anembodiment, in which the artificial acetabulum surface 65 comprises atleast one slit 66 enabling the artificial acetabulum surface 65 to varyin size for insertion through a hole smaller than the full functionalsize of the artificial acetabulum surface 65. The slits are placedbetween one or more artificial caput femur surface arms 67 which areflexible by means of the material or by means of a joint affecting theartificial acetabulum surface arms 67. The artificial acetabulum surfacecomprises a positioning hole 910 placed centrally in the artificialacetabulum surface 65 and adapted to guide, center and position theartificial acetabulum surface 65 in the hip joint in combination with anartificial caput femur surface 45 according to any on the embodimentsabove, or an artificial replacement for the entire caput femur.

FIG. 42 a shows the femoral bone where multiple positioning shafts 900a,b,c are placed in the caput femur 5. The positioning shafts 900 a,b,care adapted to guide, position and center artificial hip joint surfaceparts 913 a,b on to the caput femur 5, or guide, position and centerartificial hip joint surface parts 913 a,b to be placed in theacetabulum. The artificial hip joint surface parts 913 a,b each have apositioning hole 910 a,b which are adapted to encircle the positioningshafts 900 a,b,c placed in the caput femur 5. The artificial hip jointsurface parts 913 a,b are adapted to be connected to each other afterinsertion the hip joint using mechanical connecting members 914 a,b,wherein the mechanical connecting members comprises a first part 914 aplaced in a first artificial hip joint surface part 913 b and adapted tofit in a corresponding second part 914 b, placed in a second artificialhip joint surface part 913 a. The multiple positioning shafts 900 a,bthereby assists in the connection of multiple artificial hip jointsurface parts 913 a,b to each other. However the mechanical connectingmembers 914 a,b could be assisted or replaced by an adhesive.

FIG. 42 b shows the positioning of the artificial hip joint surfaceparts 913 a,b from above with the positioning holes 910 a,b of theartificial hip joint surface parts 913 a,b encircling the positioningshafts 900 a,b,c and thereby the positioning shafts 900 a,b,c guiding,positioning and centering the artificial hip joint surface parts 913 a,bin the hip joint.

FIG. 43 a shows a tool for placing multiple positioning shafts 900 a,b,cin the caput femur 5. The tool comprises the positioning shafts 900a,b,c which each comprise a drilling member 916 placed in the distalends of the positioning shafts 900 a,b,c. The drilling members 916 areadapted to penetrate the surface and the cortical bone of the caputfemur, and enter the cancellous bone of the collum femur 6, therebycreating holes in which the positioning shafts 900 a,b,c can be placed.The positioning shafts 900 a,b,c of the tool are connected to a basepart 917 which serves as transmission from an operation device 915, forsupplying all of the drilling members 916 with force transferred overthe positioning shafts 900 a,b,c for creating the holes in the caputfemur 5.

FIG. 43 b shows the tool from above where the positioning shafts 900a,b,c are operably connected to each other through driving elements 918,connected to the operation device 915. The driving elements 918 and thepositioning shafts 900 a,b,c are operably connected to the base part 917making up the foundation of the tool.

In embodiments where a hole 18 has been made in the pelvic bone 9 forintroduction of medical devices according to any of the embodimentsabove, it is necessary to close the hole 18 in the pelvic bone 9 using abone plug or prosthetic part. The process and embodiments of the boneplug or prosthetic part will now be described.

FIG. 44 a shows a prosthetic part 98 being inserted into a hole 18 inthe pelvic bone 9 from the opposite side from acetabulum 8. According toone embodiment the prosthetic part 98 comprises supporting members 99adapted to correspond with sections 100 of the hole 18 in the pelvicbone 9. After the prosthetic part 98 has been inserted into said hole 18in the pelvic bone 9 it is rotated so that the supporting members 99comes in contact with the pelvic bone 9 and can carry the load placed onthe acetabulum 8 from weight of the human patient through the contactwith the caput femur 5. Said prosthetic part 98 could also be adapted toserve as artificial acetabulum surface 65 according to any of the abovementioned embodiments. The prosthetic part comprises a positioning hole910 placed centrally in the prosthetic part 98 for guiding, positioningand centering the prosthetic part in the hole 18 in the pelvic bone 9and/or in relation to an artificial caput femur surface and/or anartificial acetabulum surface. The positioning hole 910 encircles apositioning shaft 900 placed in the caput femur 5.

FIG. 44 b shows the prosthetic part 98 when rotated to carry the loadplaced on the acetabulum 8 from weight of the human patient through thecontact with the caput femur 5.

FIG. 45 shows the hip joint of a human patient in section wherein theprosthetic part 98 closes the hole 18 in the pelvic bone 9 and carriesthe load placed on the acetabulum 8 from weight of the human patientthrough the contact with the caput femur 5 by means of the supportingmembers 99. The prosthetic part 98 can further be fixated to the pelvicbone 9 by means of bone cement, adhesive, screws, form fitting, welding,sprints, band or some other mechanical connecting member. According tothe embodiment of FIG. 45, a positioning shaft is placed in the collumfemur from the lateral side of the thigh, penetrating a hole 902 in thefemoral bone 7, the collum femur 6 and the caput femur 5 and enteringthrough a hole 18 in the pelvic bone 9 and into the abdomen, forguiding, positioning and centering medical devices, such as a prostheticpart as shows in FIG. 44 a,b, comprising a positioning hole 910, in thehip joint.

FIG. 46 shows the hip joint of a human patient in section wherein boneplug 31 or prosthetic part 98 is attached to the pelvic bone 9 by meansof screws 101 placed from the opposite side from acetabulum 8. Thescrews 101 are possible to place in different angles depending on reachor need for support. The positioning shaft 900 has been retracted fromthe hole 902 in the femoral bone 7 the collum femur 6 and the caputfemur 5, and a smaller hole 18 b in the bone plug 207.

FIG. 47 shows the hip joint of a human patient in section wherein a boneplug 31 is placed in the hole 18 in the pelvic bone 9 to close the hole18. According to a first embodiment the artificial acetabulum surface 65comprises supporting members 95 which carries the load placed on theacetabulum 8 from weight of the human patient through the contact withthe caput femur 5. The supporting members 95 can be adapted to bedisplaceable 97 supporting members. The bone plug 31 can be attached tothe artificial acetabulum surface 11 and/or the pelvic bone 9 by meansof bone cement, adhesive, screws, form fitting, welding, sprints, bandor some other mechanical connecting member. According to the embodimentshown in FIG. 47 an artificial caput femur surface 45 and an artificialacetabulum surface 65 has been provided, guided, positioned and centeredby a positioning shaft 900 placed in a hole 902 in the collum femur 6and the caput femur 5. The bone plug 31 also comprises a positioninghole 18 b, centrally placed, for guiding, positioning and centering thebone plug 31 for closing the hole 18 in the pelvic bone 9.

FIG. 48 shows the hip joint of a human patient in section wherein thebone plug 31 placed in the hole 18 in the pelvic bone 9 is furthersupported by supporting means 96 placed between the bone plug 31 and thepelvic bone 9 on the opposite side from acetabulum 8 using at lest oneof: bone cement, adhesive, screws, form fitting, welding, sprints, bandor some other mechanical connecting member. The positioning shaft 900 isretracted from the hole 902 in the caput femur 5 and the collum femur 6,and the hole in 18 b in the bone plug 31 after the guiding, positioningand centering of the medical devices in the hip joint is concluded.

FIG. 49 shows a bone plug 31 or a prosthetic part 98 comprising severaldisplaceable supporting members 97 adapted to carry the load placed onthe acetabulum 8 from weight of the human patient through the contactwith the caput femur 5. The displaceable parts 97 are displaced into acorresponding part in or at the edge of the hole 18 in the pelvic bone9.

This supporting means could be constructed in many different ways andthis should be seen as examples.

FIG. 50 shows the step of filling the hole 902 created in the femoralbone 7 and/or the collum femur 6 and/or the caput femur 5 and/or thehole in the pelvic bone 18 b. The injecting members 214 is adapted toinject a fluid 213 into the holes 902, 18 b, the fluid 213 could be bonecement or another biocompatible fluid adapted to harden. The injectingmembers 214 comprises a piston 216 which transfers force through a forcetransferring member 215 which could be flexible for facilitating thesurgeon reaching the area where the holes 902, 18 b is located. Afterthe step of injecting a fluid 213 adapted to harden into the hole 205 isconcluded the instruments used in the surgical or laparoscopic method isretracted and the tissue is closed in layers.

FIG. 51 shows an implantable lubrication system 920 which is adapted tolubricate the artificial hip joint surfaces after implantation in thepatient. The lubrication system 920 is adapted to lubricate theartificial hip joint surfaces intermittently, continuously or as aresponse to a sensor signal. The lubrication system comprises areservoir 924 adapted to hold the lubricating fluid 926. The reservoiris in fluid connection to an injection port 922, implantedsubcutaneously in the patient. According to the embodiment shown in FIG.51 the reservoir is spring loaded using a spring 925 placed in thereservoir and affecting a moveable wall portion, thereby placing apressure on the lubricating fluid 926 inside of the reservoir 924. Thelubricating system 920 further comprises control logic 923 forcontrolling the lubricating process by an input from the patient, e.g.through a wireless remote control, or through a sensor input, the sensorpreferably sensing the state of lubrication in the hip joint, or througha timing device for intermittently lubricating the hip joint. Thelubricating fluid 926 is transferred to the hip joint through alubricating fluid transferring member 921 placing the area of the hipjoint in which the lubricating fluid 926 should be applied, in fluidconnection with the implanted reservoir 924. The injection port 922 isplaced subcutaneously in the patient and the entire implantablelubrication system is preferably fixated to the muscular tissue of theabdomen 927, through in outer part 930 and an inner part 931 clampingthe muscular tissue 927.

FIG. 52 a shows the step of suturing 110 or stapling 111 the skin 106 ofthe human patient in the surgical method, whereas FIG. 52 b shows thestep of suturing 110 or stapling 111 the skin 106 of the human patientin the laparoscopic method.

Please note that any embodiment or part of embodiment as well as anymethod or part of method could be combined in any way. All examplesherein should be seen as part of the general description and thereforepossible to combine in any way in general terms. Please note that thedescription in general should be seen as describing both of an apparatusand a method.

The invention claimed is:
 1. An implantable medical device forimplantation in a hip joint of a human patient, the hip joint comprisinga caput femur shaped like a ball, being connected to a collum femur andbeing the upper extremity of a femoral bone, the collum femur and caputfemur having a longitudinal axial distribution with a longitudinal caputfemur centre axis reaching from the collum femur, in the centre of thecollum femur and caput femur and towards an acetabulum, the acetabulumis a bowl shaped section of the pelvic bone, with an opening towards thecaput femur, the acetabulum having an acetabulum centre axis reachingfrom the centre of the bottom of the bowl towards the centre of theopening and the normal position of the caput femur, wherein the caputfemur centre axis is aligned with the acetabulum centre axis in aspecial centered position, when the caput femur is aligned, centered andsymmetrical in the acetabulum, the caput femur and acetabulum eachhaving a hip joint carrying surface, facing each other and contactingeach other, the hip joint carrying surfaces, carrying weight in the hipjoint, wherein said medical device comprises: an artificial caput femuror an artificial caput femur surface comprising a positioningthrough-hole having at least one opening, said positioning through-holebeing adapted to receive a positioning shaft, wherein the positioningthrough-hole is adapted to at least partly surround the shaft, forpositioning said artificial caput femur or artificial caput femursurface in a desired position in the hip joint, an artificial acetabulumor an artificial acetabulum surface comprising a positioningthrough-hole having at least one opening, said positioning through-holebeing adapted to receive a positioning shaft, wherein the positioningthrough-hole is adapted to at least partly surround the shaft, forpositioning said at least one artificial hip joint surface in a desiredposition in the hip joint, and a stiff positioning shaft adapted to beplaced in a bore in at least one of the femoral bone and the pelvicbone, and adapted to penetrate the positioning through-holes of theartificial caput femur or the artificial caput femur surface or theartificial acetabulum or the artificial acetabulum surface, forpositioning said artificial caput femur or artificial caput femursurface in relation to said artificial acetabulum or artificialacetabulum surface and in relation to the femoral bone and/or the pelvicbone.
 2. The implantable medical device according to claim 1, the caputfemur having a substantially ball shaped configuration with a maximumdiameter substantially perpendicular to the caput femur centre axis,wherein said artificial caput femur surface comprises an inner surfaceand at least one first beyond part of said artificial caput femursurface adapted to cover and/or go into the bone of the caput femur onat least a part of the caput femur beyond the maximum diameter of thecaput femur along the caput femur center axis, away from the acetabulumcup towards said collum femur, when mounted on the caput femur in itsfunctional position in the joint, said at least one first beyond part isadapted to have a distance perpendicular to said caput femur centreaxis, being smaller than maximum distance from said inner surface of theartificial caput femur surface to said centre axis, perpendicular tosaid artificial caput femur surface to said centre axis, said medicaldevice thus being adapted to create a more stable position of saidartificial caput femur surface when mounted on the caput femur in saidfunctional position.
 3. The implantable medical device according toclaim 1, wherein said artificial caput femur or artificial caput femursurface and the artificial acetabulum or artificial acetabulum surfacehas a largest diameter or a largest cross-sectional distance, andwherein said largest diameter or cross sectional distance is adapted tobe changed during an operation.
 4. The implantable medical deviceaccording to claim 1, wherein said artificial acetabulum or artificialacetabulum surface are adapted to be in movable connection with saidartificial caput femur or artificial caput femur surface when implantedin the hip joint.
 5. The implantable medical device according to claim1, wherein said medical device is adapted to be fixated to at least oneof the caput femur, the collum femur and the femoral bone using afixation element.
 6. The implantable medical device according to claim5, wherein said fixation element is a fixation element selected from agroup consisting of: at least one screw, at least one pin, at least oneportion of at least one of the parts adapted to be introduced into theother part, the parts being adapted to be sliding into the other part,form fitting, welding, adhesive, pin, wire, a ball mounted into a bowlbeing portions of said parts, a male portion of one part mounted into afemale portion of the other part, a key introduced into a lock beingportions of said parts, band, and other mechanical connecting members.7. The implantable medical device according to claim 1, wherein saidartificial acetabulum surface comprises an artificial convex hip jointsurface adapted to be fixated to the pelvic bone.
 8. The implantablemedical device according to claim 1, wherein said artificial acetabulumsurface has a largest diameter or a largest cross-sectional distance,and an opening, and wherein said largest diameter or cross sectionaldistance is adapted to be changed during an operation.
 9. Theimplantable medical device according to claim 1, wherein at least one ofthe positioning hole of the artificial caput femur or artificial caputfemur surface and the positioning hole of the artificial acetabulum orartificial acetabulum surface is substantially circular.
 10. The medicaldevice according to claim 1, wherein the caput femur has a convex hipjoint surface towards the center of the hip joint, and the acetabulum,has a concave hip joint surface towards the center of the hip joint,wherein the artificial caput femur or an artificial caput femur surface,having a convex shape towards the center of the hip joint, comprisingthe first hole and the artificial acetabulum or an artificial acetabulumsurface, having a concave shape towards the center of the hip joint,comprising the second hole, wherein at least one of said artificialcaput femur or said artificial caput femur surface and said artificialacetabulum or said artificial acetabulum surface are adapted to becentered in the hip joint by said positioning shaft placed in said holeand in at least one of the femoral bone and the pelvic bone, whereinsaid artificial convex caput femur or said artificial convex caput femursurface has said first hole placed in said convex part, for enabling thepositioning shaft to be introduced into said hole and centering saidartificial convex caput femur or said artificial convex caput femursurface, when placed in the hip joint, and said artificial concaveacetabulum or said artificial concave acetabulum surface has said secondhole placed in said concave part, for enabling the positioning shaft tobe introduced into said hole and centering said artificial concaveacetabulum or said artificial concave acetabulum surface, when placed inthe hip joint, when said hip joint is placed in a centered position. 11.The medical device according to claim 1, wherein at least one of theartificial caput femur or artificial caput femur surface and theartificial acetabulum or artificial acetabulum surface has a throughgoing hole with an hole inlet and an hole outlet, said hole beingadapted to receive the positioning shaft into said hole inlet andpassing out from the hole outlet.